BALANCE SHEET DATED: ______________________________________

IN NAME OF:

ASSETS:

Cash in Bank: R ________________

Fixed Property – Market Value R ________________
Vehicles (Make & Model)_______________________________ R ________________
Furniture & Fittings: R ________________
Jewellery: R ________________
Shares in Private Companies: ___________________________ R ________________
Members/Directors Loans: ______________________________ R ________________
Other Assets: Life cover
s/v insurance policies R________________
___________________________Total: R ________________
___________________________

TOTAL ASSETS: R ________________

LIABILITIES:

Overdrafts in own name R ________________

H/P Agreements: _____________________________________ R ________________
Vehicle Finance: ______________________________________ R ________________
Home Loans: ________________________________________ R ________________
Other liabilities: __________________________
__________________________ Total: R ________________
__________________________

TOTAL LIABILITIES: R ________________

I hereby declare that this statement is given to FNB as proof of my current position, and that it is a full, true and correct statement.

_____________________________________

Signature